Immunotherapy Careplan

Allergy Injections

Allergies affect between 40 and 50 million Americans each year.  For many, their lives are constantly being disrupted by a runny nose, itchy watery eyes and wheezing.  Fortunately for them, relief is available.  A technique called immunotherapy, also known as allergy shots, can help alleviate allergies.

Allergy immunotherapy is successful in up to 90 percent of people with seasonal allergic rhinitis and in 70 to 80 percent of people with year-long allergies, according to the American Academy of Allergy, Asthma and Immunology.

What is immunotherapy and how can it improve your allergies?

Immunotherapy is an extremely effective treatment program that can increase your tolerance to substances called allergens.  Allergens (pollen, mold, animal dander) are what trigger your symptoms.  Immunotherapy reduces your allergy symptoms by changing the way your immune system responds to these allergens.  The majority of individuals treated with immunotherapy experience a significant decrease in allergy symptoms, medication use and allergy treatment costs.

Your Board Certified Allergist will combine allergy testing with a medical evaluation to identify your allergy triggers.  The actual allergy immunotherapy works like a vaccine.

How does immunotherapy work?

The treatment involves injecting the allergens that were identified as triggers of your allergy symptoms through a combination of allergy testing and a medical evaluation performed by your doctor.  Your body responds to the injected amounts of a particular allergen, given in gradually increasing doses, by developing an immunity or tolerance to the allergen.  This means that when you encounter these allergens in the future, you will have a reduced or a very minor allergic response and fewer symptoms.

How long does immunotherapy treatment last?

Immunotherapy treatment requires some dedication.  First of all, the initial treatment is once to twice weekly, resulting in many trips to your doctor’s office.  If you begin allergen immunotherapy treatment, it is very important to continue your injections on a regular basis until the treatment is completed.  During the initial build-up phase, the injections contain increasing amounts of the allergens and the frequency of injections is generally one to two times a week.  The duration of the buildup phase depends on how frequently the injections are administered, but usually ranges from four to six months.

Once the target dose is reached, the intervals between the injections can be incrementally increased to four weeks.  Generally, people receive injections for three to five years or longer.  The decision to stop immunotheraphy should be discussed with your doctor after three to five years of treatment.

Immunotherapy is continued year-round for about five years.  However, injections probably should not be stopped until the patient has gone for one year with minimal or stable symptoms.  Once allergy shots are discontinued, the duration of benefits resulting from immunotherapy varies from one individual to another.  In some, improvement is persistent.  In others, mild symptoms return, but can be controlled with medication.  A few patients develop increasing symptoms and may require re-institution of allergy shots with more prolonged therapy.

Reaching a Maintenance Dose:  A very weak concentration of allergy extract is used when allergy shots are first started.  The concentration is slowly increased until a maintenance dose is reached.  This dose should be high enough to accomplish the desired effect, but not cause an excessive local reaction or worsening of symptoms.  Not everyone needs to reach the expected maintenance dose to obtain good results.

Who should receive immunotherapy treatment?  Treatment should be considered for individuals who have allergies to inhaled (airborne) allergens and stinging insects.  The decision to begin immunotherapy should be based on several factors:

• Length of allergy season and severity of symptoms.
• How well medications control your symptoms and how many medications are required..
• Desire to avoid long-term medication use.
• Long-term commitment to treatment.

Recent Studies have suggested that immunotherapy may prevent the development of new allergies and also the development of Asthma in children who have allergic rhinitis.  Recent studies have shown that immunotherapy can help eczema as well.

Where should immunotherapy be given?  Ideally, treatment should be given in the prescribing doctor’s office.  If that is not possible, your doctor should provide the supervising physician with comprehensive instructions about your immunotherapy treatment.  You will be required to stay in the office for 20 minutes after your injections in the event of an adverse reaction to the treatment.

Are there any adverse reactions that occur from immunotherapy treatment?

There are two types of adverse reactions that can occur with immunotherapy:

1. Local reaction:

1. An acceptable reaction has redness, itching and swelling less than the size of a quarter at the site of injection and should last no longer than 24 hours.
2. Excessive swelling (larger than a quarter) with itching, redness and pain may occasionally occur. If this occurs within the first 20 minutes report immediately to the nurse. Also report this reaction to the nurse at your next allergy injection visit.
3. A delayed moderate local reaction may occur over a 24-hour period following your allergy injection. Taking an antihistamine and Tylenol or Motrin and applying an ice pack to your arm will usually relieve any discomfort. Again, please report this reaction at your next visit prior to your injection, so that your dosage can be adjusted.

2. Systemic allergic reaction

1. On rare occasions a highly sensitive individual may develop symptoms of a systemic allergic reaction. The symptoms of a systemic reaction are:  any change occurring away from the site of the injection such as itching of the throat, nose, eyes, palms, skin and/or having hives, flushing, sneezing, runny nose, coughing or wheezing.
2. Life threatening reactions have been reported in the medical literature. These reactions can occur at any time no matter how long you have been successfully on Immunotherapy.  These reactions are not well understood, but we do know that the reversibility and control of these reactions depend on how soon appropriate therapy in initiated.  Therefore it is mandatory that you wait the required 20 minutes and report immediately any symptom of a systemic reaction to the Nurse or Doctor.
3. If you have systemic symptoms outside of the office, take an antihistamine (prescription or over-the-counter) and/or anti-wheezing medication and return to our office or any closer medical facility such as the emergency room or urgent care facility. If after hours, go to an emergency room for appropriate treatment.  Call our office if seen at any other facility.
4. If more severe symptoms occur, such as feeling faint, struggling to breathe, or loss of consciousness and shock, call 911.

Remember to report any reaction (immediate or delayed) before receiving your next allergy injection so that the proper medical adjustment can be made.

Immunotherapy is a proven effective treatment for allergic rhinitis, allergic asthma and stinging insect allergy.  For many individuals immunotherapy can provide relief and a way of life that would never have been previously possible.

Injection Hours

We offer a wide range of hours; there is no need to make an appointment.

— ALLERGY INJECTION SCHEDULE —

— BE AWARE OF THE FOLLOWING POINTS —

1. If you are having unstable asthma, you should not have your allergy injection. (unstable asthma – that is taking additional meds, wheezing or excess coughing esp. at night or with exercise).  Contact our office if this persists.
2. If you have a fever, please do not come in for an allergy injection.
3. If you have a cold, without fever and or asthma symptoms, you may have your allergy injection.
4. If you are physically exhausted or overheated, do not get your allergy injection. Allow yourself 30-45 minutes to cool off before your injection and limit vigorous exercise following it.
5. All patients should have antihistamines readily available (home, office, and car) when having allergy injections due to possible reactions. We also recommend taking an antihistamine a couple hours prior to your injection. 
6. If you become pregnant when taking allergy injections, please contact our office to make an office visit prior to future injections. There is no reason to stop injections.  We will frequently maintain or lower your dose to provide extra safety against having reactions.  Studies have proven allergy injections are safe during pregnancy.
7. ** Medical Alert**  Please notify a nurse if you are taking prescription medications for:  high blood pressure, glaucoma and migraines.  Certain types of these medications may interfere with your treatment for life-threatening reactions.  Beta-blockers should be avoided, if possible, as they may promote asthma and/or interfere with treatment of a reaction.  Our nurse must know if you are taking any of these medications immediately, so appropriate decisions by the physicians can be made.
   
   
   Oral Medications:
   Acebutolol (Sectral)
   Atenolol (Tenormin)
   Betaxolol (Kerlone)
   Bisprodol (Emcor)
   Carteolol (Cartol)
   Celiprolol (Selicor)
   Esmolol (Brevibloc)
   Labetolol Hcl (Normodyne, Trandate)
   Metoprolol (Lopressor)
   Nadolol (Corgard)
   Oxyprenolol (Transicor)
   Penbutolol (Levatol)
   Pindolol (Viskin)
   Propranolol (Inderal, Intensol)
   Soltalo (Sotacor, Solalex)
   Timolol Maleate (Blocadren)
   Toprol XL
   

   Ophthalmic (EYE) Medications:
   Betaxolol Hcl (Betoptic)
   Metripranolol Hcl (Optipranolol)
   Levobunolol Hcl (Betagan)
   Timolol Maleate (Timoptic)

   Please review ALL medication labels.

8. All other medications may be used safely during Immunotherapy.
9. During a season when your allergy symptoms are most severe, the dose of your allergy extract may need to be reduced to avoid aggravating your symptoms. Frequency of your injections may increase during this time to help reduce symptoms.
10. Do not hesitate to use medications prescribed for allergy symptoms whenever it is needed. Medication may be taken for other illnesses as indicated.